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1.
BMC Nephrol ; 24(1): 120, 2023 05 01.
Article in English | MEDLINE | ID: covidwho-2327007

ABSTRACT

OBJECTIVE: To estimate the incidence of thromboembolism in children with primary nephrotic syndrome with Meta-analysis. METHODS: Relevant studies published from January 1, 1980 to December 31, 2021 were retrieved from Pubmed, Web of science, Cochrane library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database(VIP) and Wangfang Database. Quality evaluation of the literatures included was conducted according to Agency for Healthcare Research and Quality(AHRQ) assessment tool, followed by data extraction and Meta-analysis with software RevMan 5.3. RESULTS: A total of seven studies involving 3675 subjects were included. The overall prevalence was 4.9% with 95% CI of 2.83 to 7.05.However, a significant heterogeneity (P < 0.001) was observed with I2 = 89%. The prevalence of venous thromboembolism was 3.3% with 95% CI of 1.7 to 4.9. The prevalence of arterial thromboembolism was 0.5% with 95% CI of 0.2 to 1.4. CONCLUSION: Children with nephrotic syndrome are prone to thromboembolism, and it may lead to disability or death, therefore prevention measures is critical to decreasing the prevalence of thromboembolism.


Subject(s)
Nephrotic Syndrome , Thromboembolism , Humans , Child , Incidence , China , Prevalence
2.
Indian Pediatr ; 60(5): 407-408, 2023 05 15.
Article in English | MEDLINE | ID: covidwho-2313694

ABSTRACT

A multicenter retrospective study was conducted to assess the clinical spectrum of 30 severe acute respiratory syndrome coronavirus (SARS-CoV-2)-positive children with idiopathic nephrotic syndrome. Difficult to treat nephrotic syndrome was found to be a high-risk group with a high incidence of acute kidney injury and mortality.


Subject(s)
COVID-19 , Nephrotic Syndrome , Child , Humans , Nephrotic Syndrome/complications , SARS-CoV-2 , Retrospective Studies
7.
Ren Fail ; 45(1): 2163505, 2023 Dec.
Article in English | MEDLINE | ID: covidwho-2260044

ABSTRACT

PURPOSE: The risk of thromboembolic events is elevated in patients with nephrotic syndrome, and warfarin use has been associated with an increased risk of bleeding. Indobufen, a selective cyclooxygenase-1 inhibitor, is currently being evaluated for the prevention of thromboembolic events in nephrotic syndrome. This study aimed to compare the efficacy and safety of indobufen with that of warfarin in patients with nephrotic syndrome. MATERIALS AND METHODS: This multicenter, randomized, three-arm, open-label, parallel controlled trial involved a total of 180 adult patients with nephrotic syndrome from four centers in China. Patients were randomly assigned to receive 100 mg indobufen (bid), 200 mg indobufen (bid), and 3 mg warfarin (qd) daily for 12 weeks. The primary endpoints included thromboembolic and bleeding events, while laboratory results and adverse events constituted secondary endpoints. RESULTS: No thromboembolic events occurred in the high-/low-dose indobufen and warfarin groups. Moreover, the use of a low dose of indobufen significantly reduced the risk of minor bleeding events compared with warfarin use (2% versus 18%, p < .05). Finally, adverse events were more frequent in warfarin-treated patients. CONCLUSIONS: This study found that indobufen therapy provided equivalent effects in preventing thromboembolic events compared with warfarin therapy, while low dose of indobufen was associated with a reduced risk of bleeding events, thus it should be recommended for the prevention of thromboembolic events in clinical practice in patients with nephrotic syndrome. TRIAL REGISTRATION NUMBER: ChiCTR-IPR-17013428.


Subject(s)
Atrial Fibrillation , Nephrotic Syndrome , Thromboembolism , Adult , Humans , Warfarin/adverse effects , Fibrinolytic Agents/therapeutic use , Nephrotic Syndrome/complications , Nephrotic Syndrome/drug therapy , Nephrotic Syndrome/chemically induced , Anticoagulants , Thromboembolism/prevention & control , Thromboembolism/chemically induced , Hemorrhage/chemically induced , Hemorrhage/complications , Treatment Outcome
8.
BMJ Case Rep ; 16(1)2023 Jan 27.
Article in English | MEDLINE | ID: covidwho-2223611

ABSTRACT

SARS-CoV-2 infections can induce kidney injury and glomerulopathy, with the most common pathology findings being acute tubular injury and collapsing glomerulopathy.Here we describe a rare case of membranous nephropathy in a man in his late 70s presented with nephrotic syndrome and rapidly progressive kidney dysfunction 1 month after SARS-CoV-2 infection. Phospholipase A2 receptor antibodies were positive. He was treated with rituximab, with proteinuria control. We review the cases reported in the literature.


Subject(s)
COVID-19 , Glomerulonephritis, Membranous , Nephrotic Syndrome , Male , Humans , Glomerulonephritis, Membranous/diagnosis , Glomerulonephritis, Membranous/drug therapy , Glomerulonephritis, Membranous/etiology , COVID-19/complications , COVID-19/pathology , SARS-CoV-2 , Kidney/pathology , Nephrotic Syndrome/drug therapy , Nephrotic Syndrome/etiology , Nephrotic Syndrome/pathology
9.
Turk J Pediatr ; 64(6): 1117-1121, 2022.
Article in English | MEDLINE | ID: covidwho-2205363

ABSTRACT

BACKGROUND: It is already known that viral infections, exclusively upper respiratory tract infections may trigger relapses of nephrotic syndrome. Recently, COVID-19 disease has also been reported to be related with relapse of nephrotic syndrome in a few pediatric cases Case. Here we present an 8-year-old boy who had relapse of nephrotic syndrome due to COVID-19 infection. He was asymptomatic except for mild edema. He was managed supportively, no medication was started and went into spontaneous remission in 7 days. CONCLUSIONS: Viral infections particularly upper respiratory tract infections may trigger relapse of nephrotic syndrome. COVID-19 has also been reported to be related with relapses of nephrotic syndrome in a few pediatric cases. Spontaneous remission in our patient indicates the importance of close monitoring of patients before starting long term treatment with steroids.


Subject(s)
COVID-19 , Nephrotic Syndrome , Respiratory Tract Infections , Male , Humans , Child , Nephrotic Syndrome/complications , Nephrotic Syndrome/drug therapy , Remission, Spontaneous , Recurrence
10.
G Ital Nefrol ; 39(6)2022 Dec 21.
Article in English | MEDLINE | ID: covidwho-2167488

ABSTRACT

The global coronavirus 2019 (COVID-19) pandemic required vaccination even in children to reduce infection. We report on the development of acute kidney injury (AKI) and minimal change disease (MCD) nephrotic syndrome (NS), shortly after the first injection BNT162b2 COVID-19 vaccine (Pfizer-BioNTech). A 12-year-old previously healthy boy was referred to our hospital with complaints of peripheral edema and nephrotic range proteinuria. Nine days earlier he had received his first injection BNT162b2 COVID-19 vaccine (Pfizer-BioNTech). Seven days after injection, he developed leg edema, which rapidly progressed to anasarca with significant weight gain. On admission, serum creatinine was 1.3 mg/dL and 24-hour urinary protein excretion was 4 grams with fluid overload. As kidney function continued to decline over the next days, empirical steroid treatment and renal replacement therapy with ultrafiltration were started and kidney biopsy was performed. Seven days after steroid therapy, kidney function began to improve, gradually returning to normal. The association of MCD, nephrotic syndrome and AKI hasn't been previously described following the Pfizer-BioNTech COVID-19 vaccine in pediatric population, but this triad has been reported in adults. We need further similar case reports to establish the real incidence of this possible vaccine side effect.


Subject(s)
Acute Kidney Injury , COVID-19 Vaccines , COVID-19 , Nephrosis, Lipoid , Nephrotic Syndrome , Adult , Child , Humans , Male , Acute Kidney Injury/chemically induced , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Nephrosis, Lipoid/chemically induced , Steroids , Vaccination
11.
BMC Nephrol ; 23(1): 403, 2022 12 15.
Article in English | MEDLINE | ID: covidwho-2162316

ABSTRACT

BACKGROUND: Following the strong recommendation for coronavirus disease 2019 (COVID­19) vaccination, many patients with medical comorbidities are being immunized. However, the safety of vaccination in patients with autoimmune diseases has not been well established. We report a new case of biopsy-proven IgA vasculitis with nephritis presenting as a nephrotic syndrome after mRNA COVID-19 vaccination in a patient with a history of leukocytoclastic vasculitis. CASE PRESENTATION: A 76-year-old man with a history of cutaneous leukocytoclastic vasculitis presented with purpura in both lower limbs, followed by nephrotic syndrome after the second dose of BNT162b2 mRNA COVID-19 vaccination. Skin and renal biopsy revealed IgA vasculitis with nephritis. The patient's past medical history of leukocytoclastic vasculitis and features of chronicity in renal pathology suggest an acute exacerbation of preexisting IgA vasculitis after COVID-19 vaccination. After the steroid and renin-angiotensin system inhibitor use, purpura and acute kidney injury recovered within a month. Subnephrotic proteinuria with microscopic hematuria remained upon follow-up. CONCLUSION: Physicians should keep in mind the potential (re)activation of IgA vasculitis following mRNA COVID-19 vaccines. It is important to closely monitor COVID-19 vaccinated patients, particularly those with autoimmune diseases.


Subject(s)
COVID-19 Vaccines , IgA Vasculitis , COVID-19 Vaccines/adverse effects , IgA Vasculitis/chemically induced , Nephrotic Syndrome , COVID-19/prevention & control , Humans , Male , Aged
12.
High Alt Med Biol ; 23(3): 286-290, 2022 09.
Article in English | MEDLINE | ID: covidwho-2028990

ABSTRACT

Vizcarra-Vizcarra, Cristhian A., Eduardo Chávez-Velázquez, Carmen Asato-Higa, and Abdías Hurtado-Aréstegui. Treatment of focal and segmental glomerulosclerosis secondary to high altitude polycythemia with acetazolamide. High Alt Med Biol. 23:286-290, 2022.-Focal segmental glomerulosclerosis (FSGS) is a morphological pattern, caused by glomerular injury and is the leading cause of nephrotic syndrome in adults. We present the case of a 59-year-old female patient, resident of a high-altitude city (3,824 m), who had polycythemia and nephrotic syndrome. A renal biopsy was performed, and the findings were compatible with FSGS. The patient received phlebotomy 500 ml three times, which reduced, partially, the hemoglobin concentration. However, she had refractory proteinuria, despite the use of enalapril and spironolactone. We observed that proteinuria worsened with the increase in hemoglobin levels. So, she was treated with acetazolamide 250 mg bid for 4 months, which reduced proteinuria and hemoglobin. During the coronavirus disease 2019 (COVID-19) pandemic, the patient did not take acetazolamide and again, she had an increase in hemoglobin and proteinuria levels. We conclude that acetazolamide may be an effective treatment in FSGS due to high altitude polycythemia.


Subject(s)
Altitude Sickness , COVID-19 , Glomerulosclerosis, Focal Segmental , Nephrotic Syndrome , Polycythemia , Acetazolamide/therapeutic use , Adult , Altitude , Altitude Sickness/complications , Altitude Sickness/drug therapy , Female , Glomerulosclerosis, Focal Segmental/complications , Glomerulosclerosis, Focal Segmental/etiology , Humans , Middle Aged , Nephrotic Syndrome/complications , Nephrotic Syndrome/pathology , Polycythemia/complications , Polycythemia/etiology , Proteinuria/etiology
13.
PLoS One ; 17(8): e0272237, 2022.
Article in English | MEDLINE | ID: covidwho-2002304

ABSTRACT

OBJECTIVE: By analyzing the pathological characteristics and clinical data of renal biopsy in our hospital in the past 20 years, to further understand the epidemic characteristics and pathological changes of primary glomerular disease, and to provide regional data for the big data of kidney disease in my country. METHODS: A retrospective analysis of 9448 patients with primary glomerular disease who were hospitalized in our hospital from January 1, 2000 to December 31, 2019, aged 18 years or older, and undergoing renal biopsy. Divided every 5 years into a group, a total of 4 groups (first group 2000.1.1-2004.12.31, second groups 2005.1.1-2009.12.31; third groups 2010.1.1-2014.12.31, fourth groups 2015.1.1-2019.12.31). RESULTS: ① There were more males than females, and male: female vs 1.53:1. The proportion of men in the past five years has increased compared with the previous 15 years. ② Mostly middle-aged, with a median age of 41.39 years old. The age is increasing over time. There are differences between the four groups, P <0.001; ③ The most common clinical manifestations are nephrotic syndrome, followed by chronic glomerulonephritis. Occult glomerulonephritis, the proportion of patients with nephrotic syndrome increases over time, first to fourth group (40.08%< 42.64% < 47.08%< 53.69%); ④ The most common pathology type from 2000 to 2009 was mesangial proliferative glomerulonephritis. IgA nephropathy was the most common type from 2010 to 2014, but the proportion of membranous nephropathy increased year by year, and it became the most common pathological type from 2015 to 2019; ⑤ The clinical and pathological manifestations of different genders are different, but there is no statistical difference. CONCLUSION: In the past 20 years, the primary glomerular disease is mainly middle-aged. There are more men than women. The most common type of clinical manifestation is nephrotic syndrome. The pathological type is mesangial proliferative glomerulonephritis. Over time, the average age is increasing, and the proportion of patients with renal syndrome is increasing. IgA nephropathy is the most common pathological type from 2010 to 2014, and membranous nephropathy has become the main pathological type in the past 5 years.


Subject(s)
Glomerulonephritis, IGA , Glomerulonephritis, Membranous , Glomerulonephritis , Nephrotic Syndrome , Vascular Diseases , Adult , Biopsy , Female , Glomerulonephritis/epidemiology , Glomerulonephritis/pathology , Glomerulonephritis, IGA/epidemiology , Glomerulonephritis, IGA/pathology , Glomerulonephritis, Membranous/epidemiology , Glomerulonephritis, Membranous/pathology , Humans , Kidney/pathology , Male , Middle Aged , Nephrotic Syndrome/epidemiology , Nephrotic Syndrome/pathology , Retrospective Studies , Vascular Diseases/pathology
15.
Medicina (Kaunas) ; 58(5)2022 May 11.
Article in English | MEDLINE | ID: covidwho-1875700

ABSTRACT

Levamisole is effectively used in steroid-dependent nephrotic syndrome and the more frequent side effects reported are cytopenia and liver enzymes alterations. Several studies have demonstrated that this drug can induce high titers of circulating perinuclear antineutrophil cytoplasmic autoantibodies (ANCA) and vasculitis, most of them occurring in the case of prolonged use. A four-year-old boy that was affected with steroid-dependent nephrotic syndrome was treated with Levamisole as a steroid-sparing agent at a dose of 2 mg/kg/48 h. After initiation of the treatment, the number of relapses drastically decreased, enabling a significant reduction in the cumulative steroid dose. Levamisole was well tolerated, and was therefore administered for several years. At the age of 15, he was also diagnosed with celiac disease. After nine years of continuous Levamisole treatment, he presented with a high fever, hand and foot joint arthritis, and increased levels of total and direct bilirubin. Since the symptoms started two days after the injection of the second dose of the COVID-19 vaccine, it was initially concluded that these manifestations were rare vaccination side effects. Therefore, he did not receive any specific treatments, and Levamisole was continued at the same dose. After an initial improvement, two months later, the patient presented with the same symptoms. Suspecting Levamisole-induced vasculitis, an ANCA titer was measured and this returned positive. Clinical manifestations and double positivity for both myeloperoxidase (MPO) and anti-proteinase 3 (PR3) antibodies argued against the fact that that these findings were secondary to vaccination, cocaine abuse, or celiac disease. Assuming that we were facing a rare drug reaction, Levamisole was promptly interrupted. This resulted in a rapid remission of fever and arthritis improvement, and a decrease in ANCA titers. By reporting this case, we want to raise awareness among clinicians regarding a rare complication of treatment with Levamisole that is often misdiagnosed due to the fact that the current literature lacks univocal guidelines regarding the precise timing of ANCA titrations and the duration of the treatment.


Subject(s)
Arthritis , COVID-19 , Celiac Disease , Nephrotic Syndrome , Vasculitis , Antibodies, Antineutrophil Cytoplasmic , COVID-19 Vaccines , Child, Preschool , Humans , Levamisole/adverse effects , Male , Neoplasm Recurrence, Local , Vasculitis/chemically induced
16.
JAMA Pediatr ; 176(3): 236-243, 2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1864299

ABSTRACT

IMPORTANCE: In children with corticosteroid-sensitive nephrotic syndrome, many relapses are triggered by upper respiratory tract infections. Four small studies found that administration of daily low-dose prednisolone for 5 to 7 days at the time of an upper respiratory tract infection reduced the risk of relapse, but the generalizability of their findings is limited by location of the studies and selection of study population. OBJECTIVE: To investigate the use of daily low-dose prednisolone for the treatment of upper respiratory tract infection-related relapses. DESIGN, SETTING, AND PARTICIPANTS: This double-blind, placebo-controlled randomized clinical trial (Prednisolone in Nephrotic Syndrome [PREDNOS] 2) evaluated 365 children with relapsing steroid-sensitive nephrotic syndrome with and without background immunosuppressive treatment at 122 pediatric departments in the UK from February 1, 2013, to January 31, 2020. Data from the modified intention-to-treat population were analyzed from July 1, 2020, to December 31, 2020. INTERVENTIONS: At the start of an upper respiratory tract infection, children received 6 days of prednisolone, 15 mg/m2 daily, or matching placebo preparation. Those already taking alternate-day prednisolone rounded their daily dose using trial medication to the equivalent of 15 mg/m2 daily or their alternate-day dose, whichever was greater. MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of first upper respiratory tract infection-related relapse. Secondary outcomes included overall rate of relapse, changes in background immunosuppressive treatment, cumulative dose of prednisolone, rates of serious adverse events, incidence of corticosteroid adverse effects, and quality of life. RESULTS: The modified intention-to-treat analysis population comprised 271 children (mean [SD] age, 7.6 [3.5] years; 174 [64.2%] male), with 134 in the prednisolone arm and 137 in the placebo arm. The number of patients experiencing an upper respiratory tract infection-related relapse was 56 of 131 (42.7%) in the prednisolone arm and 58 of 131 (44.3%) in the placebo arm (adjusted risk difference, -0.02; 95% CI, -0.14 to 0.10; P = .70). No evidence was found that the treatment effect differed according to background immunosuppressive treatment. No significant differences were found in secondary outcomes between the treatment arms. A post hoc subgroup analysis assessing the primary outcome in 54 children of South Asian ethnicity (risk ratio, 0.66; 95% CI, 0.40-1.10) vs 208 children of other ethnicity (risk ratio, 1.11; 95% CI, 0.81-1.54) found no difference in efficacy of intervention in those of South Asian ethnicity (test for interaction P = .09). CONCLUSIONS AND RELEVANCE: The results of PREDNOS 2 suggest that administering 6 days of daily low-dose prednisolone at the time of an upper respiratory tract infection does not reduce the risk of relapse of nephrotic syndrome in children in the UK. Further work is needed to investigate interethnic differences in treatment response. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN10900733; EudraCT 2012-003476-39.


Subject(s)
Nephrotic Syndrome , Respiratory Tract Infections , Adrenal Cortex Hormones/therapeutic use , Child , Humans , Male , Nephrotic Syndrome/complications , Nephrotic Syndrome/drug therapy , Prednisolone/therapeutic use , Quality of Life , Recurrence , Respiratory Tract Infections/drug therapy , Respiratory Tract Infections/prevention & control
17.
Clin Exp Nephrol ; 26(9): 909-916, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1844393

ABSTRACT

BACKGROUND: Recent clinical reports indicate a correlation between new-onset and relapse of nephrotic syndrome (NS) following coronavirus 2019 (COVID-19) vaccination in patients with glomerular diseases. However, there are no reports of a nationwide survey on NS following COVID-19 vaccination in Japan. METHODS: We conducted a web-based survey of council members of the Japanese Society of Nephrology (581 members, 382 facilities) to elucidate the relationship between COVID-19 vaccination and new-onset and relapse of NS. RESULTS: Following COVID-19 vaccination, 27 patients (male: 15, 55.6%) with new-onset (n = 6) and relapse (n = 21) of NS were reported. Of them, 12 (44.4%) patients were diagnosed with minimal change disease at the occurrence of NS. Five patients developed a slight increase in serum creatinine levels; however, none progressed to severe renal dysfunction. CONCLUSION: Our findings clarify the clinical features of new-onset and relapse of NS following COVID-19 vaccination. Although there was no obvious progression to severe renal dysfunction, clinicians and pathologists should be aware that NS is a potential adverse effect of the vaccines.


Subject(s)
COVID-19 Vaccines , COVID-19 , Nephrotic Syndrome , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Japan/epidemiology , Male , Nephrotic Syndrome/epidemiology , Nephrotic Syndrome/etiology , Recurrence , Surveys and Questionnaires , Vaccination/adverse effects
18.
Pediatr Nephrol ; 37(11): 2679-2685, 2022 11.
Article in English | MEDLINE | ID: covidwho-1844375

ABSTRACT

BACKGROUND: Infections are thought to be primarily responsible for triggering relapse in children with steroid-sensitive nephrotic syndrome (NS). The COVID-19 pandemic promoted physical distancing, facial mask wearing, and greater attention to infection-prevention measures resulting in decreased transmission of infections. We hypothesized there would also be a decreased rate of NS relapse during this period. METHODS: We conducted a single-center retrospective chart review of children with steroid-sensitive NS. Demographics, rate of relapses, and rate of hospitalizations were collected for a baseline pre-pandemic period (BPP) and for the social distancing period during the pandemic (SDP). RESULTS: One hundred twenty-two children with primary steroid-sensitive NS were identified and 109 were followed for the duration of the study period. The paired rate of relapse per subject per year was significantly lower during the SDP (0.6 relapses per subject per year ± 1 SD) compared to the BPP (1.0 relapses per subject per year ± 0.9 SD), P < 0.01. A subgroup of 32 subjects who were newly diagnosed with NS during the BPP similarly had significantly fewer relapses during the SDP (0.8 ± 1 SD) than during the BPP (1.4 ± 1 SD), P = 0.01. CONCLUSIONS: Our results support the hypothesis of lower rates of NS relapse and hospitalizations during social distancing for all subjects in our cohort and a subgroup of those newly diagnosed. Lower relapse rates were likely attributable to decreased transmission of infections and greater attention to infection prevention. A higher resolution version of the Graphical abstract is available as Supplementary information.


Subject(s)
COVID-19 , Nephrosis, Lipoid , Nephrotic Syndrome , COVID-19/epidemiology , Child , Chronic Disease , Humans , Nephrotic Syndrome/diagnosis , Nephrotic Syndrome/epidemiology , Pandemics/prevention & control , Recurrence , Retrospective Studies , Steroids
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